Analysis of risk factors for retrograde type A aortic dissection after endovascular repair of Stanford type B aortic dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DENG Liwen , WANG Zichang , ZUO Xiangyi , ZHAO Yu ,  WANG Xuehu

Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding author：

WANG Xuehu, Email: wangxuehu@hospital.cqmu.edu.cn

Keywords：

Stanford type B aortic dissection; thoracic endovascular aortic repair; retrograde type A aortic dissection; risk factors

DOI：

10.7507/1007-9424.202408020

Video：

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Objective To analyze the risk factors relevant retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection and provide a reference for its prevention and management. Methods A retrospective analysis was conducted on patients with Stanford type B aortic dissection who underwent TEVAR at the First Affiliated Hospital of Chongqing Medical University from January 2017 to June 2023. The patients met the inclusion and exclusion criteria were included in the study. The multivariate logistic regression was used to analyze the risk factors for RTAD, with a test level of α=0.05. Results A total of 176 patients were included, among whom 7 developed RTAD, with an occurrence rate of 3.98%. The multivariate logistic regression analysis revealed that the larger τ angle between the centerline of the aorta [OR(95%CI)=1.195(1.032, 1.384)] and the degree of curvature of the aortic arch (the curve distance from the proximal brachiocephalic trunk to the distal left subclavian artery) [OR(95%CI)=0.756(0.572, 0.999)], the higher probability of RTAD after TEVAR (P＜0.05). Conclusions From the results of this study, it can be seen that for patients with Stanford B-type aortic dissection underwent TEVAR treatment, careful preoperative evaluation of morphological characteristics of the aortic arch (particularly the τ angle of the aorta centerline and the degree of curvature of the aortic arch (the curve distance from the proximal brachiocephalic trunk to the distal left subclavian artery) is crucial for reducing the occurrence of RTAD after TEVAR in patients with Stanford type B aortic dissection.

1.	Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on clinical practice guidelines. Circulation, 2022, 146(24): e334-e482. doi: 10.1161/CIR.0000000000001106.
2.	Higashigawa T, Kato N, Chino S, et al. Type A aortic dissection after thoracic endovascular aortic repair. Ann Thorac Surg, 2016, 102(5): 1536-1542.
3.	Wang L, Zhao Y, Zhang W, et al. Retrograde type A aortic dissection after thoracic endovascular aortic repair: Incidence, time trends and risk factors. Semin Thorac Cardiovasc Surg, 2021, 33(3): 639-653.
4.	Dong ZH, Fu WG, Wang YQ, et al. Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection. Circulation, 2009, 119(5): 735-741.
5.	Ali-Hasan-Al-Saegh S, Halloum N, Scali S, et al. A systematic review and meta-analysis of retrograde type A aortic dissection after thoracic endovascular aortic repair in patients with type B aortic dissection. Medicine (Baltimore), 2023, 102(15): e32944. doi: 10.1097/MD.0000000000032944.
6.	中华医学会放射学分会介入学组. 中国Stanford B型主动脉夹层影像诊断和介入治疗临床指南. 中华放射学杂志, 2023, 57(5): 457-473.
7.	Li D, Peng L, Wang Y, et al. Predictor of false lumen thrombosis after thoracic endovascular aortic repair for type B dissection. J Thorac Cardiovasc Surg, 2020, 160(2): 360-367.
8.	Neuhauser B, Greiner A, Jaschke W, et al. Serious complications following endovascular thoracic aortic stent-graft repair for type B dissection. Eur J Cardiothorac Surg, 2008, 33(1): 58-63.
9.	Usai MV, Nugroho NT, Oberhuber A, et al. Influence of TEVAR on blood pressure in subacute type B aortic dissection (TBAD) patients with refractory and non-refractory arterial hypertension. Int Angiol, 2021, 40(1): 60-66.
10.	Khayat M, Cooper KJ, Khaja MS, et al. Endovascular management of acute aortic dissection. Cardiovasc Diagn Ther, 2018, 8(Suppl 1): S97-S107. doi: 10.21037/cdt.2017.10.07.
11.	Wang GQ, Qin YF, Shi ST, et al. Retrograde type A aortic dissection during or after thoracic endovascular aortic repair: a single center 16-year experience. Front Cardiovasc Med, 2023, 10: 1160142. doi: 10.3389/fcvm.2023.1160142.
12.	Beck AW, Wang G, Lombardi JV, et al. Retrograde type A dissection in the Vascular Quality Initiative thoracic endovascular aortic repair for dissection postapproval project. J Vasc Surg, 2022, 75(5): 1539-1551.
13.	Erbel R, Oelert H, Meyer J, et al. Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography. Circulation, 1993, 87(5): 1604-1615.
14.	Kazui T, Tamiya Y, Tanaka T, et al. Extended aortic replacement for acute type A dissection with the tear in the descending aorta. J Thorac Cardiovasc Surg, 1996, 112(4): 973-978.
15.	Yammine H, Briggs CS, Stanley GA, et al. Retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2019, 69(1): 24-33.
16.	Khoynezhad A, White RA. Pathogenesis and management of retrograde type A aortic dissection after thoracic endovascular aortic repair. Ann Vasc Surg, 2013, 27(8): 1201-1206.
17.	Wang G, Zhai S, Li T, et al. Mechanism and management of retrograde type A aortic dissection complicating TEVAR for type B aortic dissection. Ann Vasc Surg, 2016, 32: 111-118.
18.	Dumfarth J, Michel M, Schmidli J, et al. Mechanisms of failure and outcome of secondary surgical interventions after thoracic endovascular aortic repair (TEVAR). Ann Thorac Surg, 2011, 91(4): 1141-1146.
19.	Ma T, Dong ZH, Wang S, et al. Computational investigation of interaction between stent graft and aorta in retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2018, 68(6S): 14S-21S. e2. doi: 10.1016/j.jvs.2018.06.008.
20.	Kpodonu J, Preventza O, Ramaiah VG, et al. Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real?. Eur J Cardiothorac Surg, 2008, 33(6): 1014-1018.
21.	Bellos JK, Petrosyan A, Abdulamit T, et al. Retrograde type A aortic dissections after endovascular stent-graft placement for type B dissection. J Cardiovasc Surg (Torino), 2010, 51(1): 85-93.
22.	Noguchi K, Hori D, Nomura Y, et al. Iatrogenic acute aortic dissection during percutaneous coronary intervention for acute myocardial infarction. Ann Vasc Dis, 2012, 5(1): 78-81.
23.	Canaud L, Ozdemir BA, Patterson BO, et al. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg, 2014, 260(2): 389-395.
24.	Liu L, Zhang S, Lu Q, et al. Impact of oversizing on the risk of retrograde dissection after TEVAR for acute and chronic type B dissection. J Endovasc Ther, 2016, 23(4): 620-625.
25.	Preventza O, Garcia A, Moeller K, et al. Retrograde ascending aortic dissection after thoracic endovascular aortic repair for distal aortic dissection or with zone 0 landing: Association, risk factors, and true incidence. Ann Thorac Surg, 2015, 100(2): 509-515.
26.	Chang H, Wang Y, Liu B, et al. Endovascular repair for acute type B aortic dissection with unfavorable proximal landing zone. Ann Thorac Surg, 2022, 113(2): 545-553.
27.	Xiang D, Wu F, Chen L, et al. Timing of endovascular repair impacts long-term outcomes of uncomplicated acute type B aortic dissection. J Vasc Surg, 2022, 75(3): 851-860.
28.	Böckler D, Schumacher H, Ganten M, et al. Complications after endovascular repair of acute symptomatic and chronic expanding Stanford type B aortic dissections. J Thorac Cardiovasc Surg, 2006, 132(2): 361-368.
29.	Williams JB, Andersen ND, Bhattacharya SD, et al. Retrograde ascending aortic dissection as an early complication of thoracic endovascular aortic repair. J Vasc Surg, 2012, 55(5): 1255-1262.
30.	Gandet T, Canaud L, Ozdemir BA, et al. Factors favoring retrograde aortic dissection after endovascular aortic arch repair. J Thorac Cardiovasc Surg, 2015, 150(1): 136-142.
31.	Fernández-Alonso L, Fernández Alonso S, Martínez Aguilar E, et al. Fenestrated and scalloped endovascular grafts in zone 0 and zone 1 for aortic arch disease. Ann Vasc Surg, 2020, 69: 360-365.
32.	舒畅, 何昊, 李全明, 等. 新型一体三分支支架系统用于主动脉弓部病变的FIM研究. 中国普通外科杂志, 2023, 32(6): 824-831.
33.	王国权, 翟水亭, 史帅涛, 等. Stanford B型主动脉夹层腔内修复术并发逆行性A型夹层的治疗策略及结果分析. 中华放射学杂志, 2021, 55(5): 495-499.
34.	肖长波, 喻红霞, 毛蕾芳, 等. 胸主动脉腔内修复术后再发StanfordA型主动脉夹层的外科治疗. 中华外科杂志, 2021, 59(6): 520-524.
35.	Spielvogel D, Strauch JT, Minanov OP, et al. Aortic arch replacement using a trifurcated graft and selective cerebral antegrade perfusion. Ann Thorac Surg, 2002, 74(5): S1810-S1832. doi: 10.1016/s0003-4975(02)04156-5.

1. Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on clinical practice guidelines. Circulation, 2022, 146(24): e334-e482. doi: 10.1161/CIR.0000000000001106.
2. Higashigawa T, Kato N, Chino S, et al. Type A aortic dissection after thoracic endovascular aortic repair. Ann Thorac Surg, 2016, 102(5): 1536-1542.
3. Wang L, Zhao Y, Zhang W, et al. Retrograde type A aortic dissection after thoracic endovascular aortic repair: Incidence, time trends and risk factors. Semin Thorac Cardiovasc Surg, 2021, 33(3): 639-653.
4. Dong ZH, Fu WG, Wang YQ, et al. Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection. Circulation, 2009, 119(5): 735-741.
5. Ali-Hasan-Al-Saegh S, Halloum N, Scali S, et al. A systematic review and meta-analysis of retrograde type A aortic dissection after thoracic endovascular aortic repair in patients with type B aortic dissection. Medicine (Baltimore), 2023, 102(15): e32944. doi: 10.1097/MD.0000000000032944.
6. 中华医学会放射学分会介入学组. 中国Stanford B型主动脉夹层影像诊断和介入治疗临床指南. 中华放射学杂志, 2023, 57(5): 457-473.
7. Li D, Peng L, Wang Y, et al. Predictor of false lumen thrombosis after thoracic endovascular aortic repair for type B dissection. J Thorac Cardiovasc Surg, 2020, 160(2): 360-367.
8. Neuhauser B, Greiner A, Jaschke W, et al. Serious complications following endovascular thoracic aortic stent-graft repair for type B dissection. Eur J Cardiothorac Surg, 2008, 33(1): 58-63.
9. Usai MV, Nugroho NT, Oberhuber A, et al. Influence of TEVAR on blood pressure in subacute type B aortic dissection (TBAD) patients with refractory and non-refractory arterial hypertension. Int Angiol, 2021, 40(1): 60-66.
10. Khayat M, Cooper KJ, Khaja MS, et al. Endovascular management of acute aortic dissection. Cardiovasc Diagn Ther, 2018, 8(Suppl 1): S97-S107. doi: 10.21037/cdt.2017.10.07.
11. Wang GQ, Qin YF, Shi ST, et al. Retrograde type A aortic dissection during or after thoracic endovascular aortic repair: a single center 16-year experience. Front Cardiovasc Med, 2023, 10: 1160142. doi: 10.3389/fcvm.2023.1160142.
12. Beck AW, Wang G, Lombardi JV, et al. Retrograde type A dissection in the Vascular Quality Initiative thoracic endovascular aortic repair for dissection postapproval project. J Vasc Surg, 2022, 75(5): 1539-1551.
13. Erbel R, Oelert H, Meyer J, et al. Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography. Circulation, 1993, 87(5): 1604-1615.
14. Kazui T, Tamiya Y, Tanaka T, et al. Extended aortic replacement for acute type A dissection with the tear in the descending aorta. J Thorac Cardiovasc Surg, 1996, 112(4): 973-978.
15. Yammine H, Briggs CS, Stanley GA, et al. Retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2019, 69(1): 24-33.
16. Khoynezhad A, White RA. Pathogenesis and management of retrograde type A aortic dissection after thoracic endovascular aortic repair. Ann Vasc Surg, 2013, 27(8): 1201-1206.
17. Wang G, Zhai S, Li T, et al. Mechanism and management of retrograde type A aortic dissection complicating TEVAR for type B aortic dissection. Ann Vasc Surg, 2016, 32: 111-118.
18. Dumfarth J, Michel M, Schmidli J, et al. Mechanisms of failure and outcome of secondary surgical interventions after thoracic endovascular aortic repair (TEVAR). Ann Thorac Surg, 2011, 91(4): 1141-1146.
19. Ma T, Dong ZH, Wang S, et al. Computational investigation of interaction between stent graft and aorta in retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2018, 68(6S): 14S-21S. e2. doi: 10.1016/j.jvs.2018.06.008.
20. Kpodonu J, Preventza O, Ramaiah VG, et al. Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real?. Eur J Cardiothorac Surg, 2008, 33(6): 1014-1018.
21. Bellos JK, Petrosyan A, Abdulamit T, et al. Retrograde type A aortic dissections after endovascular stent-graft placement for type B dissection. J Cardiovasc Surg (Torino), 2010, 51(1): 85-93.
22. Noguchi K, Hori D, Nomura Y, et al. Iatrogenic acute aortic dissection during percutaneous coronary intervention for acute myocardial infarction. Ann Vasc Dis, 2012, 5(1): 78-81.
23. Canaud L, Ozdemir BA, Patterson BO, et al. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg, 2014, 260(2): 389-395.
24. Liu L, Zhang S, Lu Q, et al. Impact of oversizing on the risk of retrograde dissection after TEVAR for acute and chronic type B dissection. J Endovasc Ther, 2016, 23(4): 620-625.
25. Preventza O, Garcia A, Moeller K, et al. Retrograde ascending aortic dissection after thoracic endovascular aortic repair for distal aortic dissection or with zone 0 landing: Association, risk factors, and true incidence. Ann Thorac Surg, 2015, 100(2): 509-515.
26. Chang H, Wang Y, Liu B, et al. Endovascular repair for acute type B aortic dissection with unfavorable proximal landing zone. Ann Thorac Surg, 2022, 113(2): 545-553.
27. Xiang D, Wu F, Chen L, et al. Timing of endovascular repair impacts long-term outcomes of uncomplicated acute type B aortic dissection. J Vasc Surg, 2022, 75(3): 851-860.
28. Böckler D, Schumacher H, Ganten M, et al. Complications after endovascular repair of acute symptomatic and chronic expanding Stanford type B aortic dissections. J Thorac Cardiovasc Surg, 2006, 132(2): 361-368.
29. Williams JB, Andersen ND, Bhattacharya SD, et al. Retrograde ascending aortic dissection as an early complication of thoracic endovascular aortic repair. J Vasc Surg, 2012, 55(5): 1255-1262.
30. Gandet T, Canaud L, Ozdemir BA, et al. Factors favoring retrograde aortic dissection after endovascular aortic arch repair. J Thorac Cardiovasc Surg, 2015, 150(1): 136-142.
31. Fernández-Alonso L, Fernández Alonso S, Martínez Aguilar E, et al. Fenestrated and scalloped endovascular grafts in zone 0 and zone 1 for aortic arch disease. Ann Vasc Surg, 2020, 69: 360-365.
32. 舒畅, 何昊, 李全明, 等. 新型一体三分支支架系统用于主动脉弓部病变的FIM研究. 中国普通外科杂志, 2023, 32(6): 824-831.
33. 王国权, 翟水亭, 史帅涛, 等. Stanford B型主动脉夹层腔内修复术并发逆行性A型夹层的治疗策略及结果分析. 中华放射学杂志, 2021, 55(5): 495-499.
34. 肖长波, 喻红霞, 毛蕾芳, 等. 胸主动脉腔内修复术后再发StanfordA型主动脉夹层的外科治疗. 中华外科杂志, 2021, 59(6): 520-524.
35. Spielvogel D, Strauch JT, Minanov OP, et al. Aortic arch replacement using a trifurcated graft and selective cerebral antegrade perfusion. Ann Thorac Surg, 2002, 74(5): S1810-S1832. doi: 10.1016/s0003-4975(02)04156-5.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesAnalysis of risk factors for retrograde type A aortic dissection after endovascular repair of Stanford type B aortic dissection

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